Objective-To find out perimenopausal women's views on taking hormone replacement therapy to prevent osteoporosis.Design-Semistructured postal questionnaire survey; the questionnaire was enclosed with a letter to explain the purpose of the study and to give patients some information about hormone replacement therapy and osteoporosis.Setting-Mixed social class, urban general practice with 12 000 registered patients.Patients-All women aged 50, 51, or 52 were selected from the age-sex register; 102 women were identified and 84 (87%) replied to the questionnaire.Main outcome measures-Response rates to questions on interest in taking hormone replacement therapy, the importance of preventing osteoporosis, and worries about side effects of the treatment.Results-More than three quarters of the respondents (65) were interested in taking hormone replacement therapy to prevent osteoporosis, but 48 of them would have liked further information. Sixty four women thought that it was very important to prevent osteoporosis. More than half of the respondents (51) were worried about side effects of the treatment, but only 15 women thought that continued menstruation would be a major disadvantage.Conclusions-There is considerable interest among perimenopausal women in taking hormone replacement therapy to prevent osteoporosis. The resource implications for primary care in meeting this interest are substantial.

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There has been a constant search for new drugs to treat endocrine disturbances, particularly those of infertility. Norethynodrel,* a 19-nortestosterone derivative, has a unique action on the endometrium. It has been thought to exert a progesterone effect on the human endometrium without estrogenic priming, although it has been uncertain whether all components of the endometrium reacted similarly to this compound.' Revision of our current thinking regarding endocrine metabolism during the menstrual cycle might be necessary if endocrine substances such as norethynodrel should show a selective action on various parts of the endometrium. MATERIALS AND METIIODSFifty-four private patients between 20 and 36 years of age were studied while under treatment for infertility. Ovulation was demonstrated in 15 (control group). Thirty-nine had anovulatory cycles (endometrial biopsies and basal body temperature) and 7 of these had secondary amenorrhea.One patient from the amenorrhea group has been under treatment for 8 months. Endometrial biopsies were obtained from all patients on the twenty-fifth day of the menstrual cycle, before and after treatment. Biopsies were taken from amenorrheic patients immediately before treatment. Thirty-four patients (all groups) were placed on norethynodrel, 10 mg. daily for 10 to 20 days. Twenty mg. daily was given to 20 patients (all groups) for 10 to 20 consecutive days. The medication was started either on the fourth day of the cycle and continued for the next 20 days, or on the twelfth day of the cycle and continued for 10 to 18 days. OBSERVATIONS Normal OvulationFifty-three patients were treated from 1 to 4 cycles.Ten mg. norethynodrel daily f r o m the fourth to twenty-fourth day of the cycle (10 patients). For the most part, the glands were arrested in the early follicular phase, with some showing slight dilatation in patients with normal ovulatory cycles. The glands were lined with either high or low columnar epithelium, with a minimum amount of secretion. The cytoplasm stained poorly.There were some hemorrhagic areas (FIGURES 1 and 2).The response of the endometrium was different when norethynodrel was started a t the mid-cycle. The glands, arrested a t the late proliferative phase, became dilated and cystic. The epithelium was flattened because of the The stroma was cellular, with some edema.T e n mg. daily from the twelfth to thirtieth day of the cycle (5 patients).

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